Cream Skimming by Health Care Providers and Inequality in Health Care Access: Evidence from a Randomized Field Experiment

Anna Werbeck, Ansgar Wübker () and Nicolas Ziebarth ()

No 28809, NBER Working Papers from National Bureau of Economic Research, Inc

Abstract: Using a randomized field experiment, we show that health care specialists cream-skim patients by their expected profitability. In the German two-tier system, outpatient reimbursement rates for both public and private insurance are centrally determined but are significantly higher for the privately insured. In our field experiment, following a standardized protocol, the same hypothetical patient called 991 private practices in 36 German counties to schedule appointments for allergy tests, hearing tests and gastroscopies. Practices were 4% more likely to offer an appointment to the privately insured. Conditional on being offered an appointment, wait times for the publicly insured were twice as long than for the privately insured. We also find smaller access differences when reimbursement rate differences are smaller. Our findings show that structural differences in reimbursement rates lead to structural differences in health care access.

JEL-codes: I11 I14 I18 (search for similar items in EconPapers)
Date: 2021-05
New Economics Papers: this item is included in nep-exp, nep-hea and nep-ias
Note: EH
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Citations: View citations in EconPapers (9)

Published as Werbeck, Anna & Wübker, Ansgar & Ziebarth, Nicolas R., 2021. "Cream skimming by health care providers and inequality in health care access: Evidence from a randomized field experiment," Journal of Economic Behavior & Organization, Elsevier, vol. 188(C), pages 1325-1350.

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Journal Article: Cream skimming by health care providers and inequality in health care access: Evidence from a randomized field experiment (2021)
Working Paper: Cream Skimming by Health Care Providers and Inequality in Health Care Access: Evidence from a Randomized Field Experiment (2020)
Working Paper: Cream skimming by health care providers and inequality in health care access: Evidence from a randomized field experiment (2020)
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